Interviews with orthopedic doctors after cortisone shots were not working, all concurred-bone on bone, no meniscus, total bone degeneration

One more half marathon: barely could finish with a kick, did a 2:06, my slowest ever and my most worrisome journey ever. My left knee kept wanting to collapse. I cannot fall due to having osteoporosis…lots of factors going on.

Decided without a doubt to get the surgery done after Euflexa-injection shots proved to make the knee worse

November/2012

Fighting the good fight to try to qualify for Boston one more time, found out my knee could not be used for more than an hour without tremendous swelling Still able to win my age group…on short races – Rattlesnake 5 mile-same time as last year Ready to give up running; but found out the knee gets worse without normal use (45 years of running), Found out my leg begins to buckle after 6 miles or so; collapses after the swelling goes up and the knee continually wants to collapse after 6 miles or so. One more half: Lady Speed…could not sustain left leg take-off after mile 6; ave. 10:30 pace…but, finished last mile with two legs-collapsed at end due to knee buckling – 2:23 (last year-2:01)

One more 5K race would be done, before I quit running; time slowed down a 3 min…cannot utilize my left leg for fast up and down motion-Turkey Trot – 27:00

11/20 - I have to run! After track session I remembered that with asthma, I must run because it forces my lungs to go aerobic-forcing oxygen in and carbon dioxide out. I run to breathe.

11/21 – Biking is extremely painful due to the forced flexion/bending on the knee joint, however, it is this type of cross-training which I will be doing after the TKR. Also, I want to keep as much leg turnover as possible…and be outside.

11/22 - One more 5K race; time slowed down a 3 min…cannot utilize my left leg for fast up and down motion-Turkey Trot – 27:00

11/23 – The shoe! Reading about the need to have the knee stable made me realize that a stability trainer will be essential…I must keep legs and hips in equal alignment and reduce pronation of hips and foot stike.

12/18 – Surgery…flawless I was told. A total nerve block was put in the knee to subtract the actual pain of cutting the bone, searing ligaments, cutting muscles, etc. More on that later

12/19 – Enormous amount of pain medication given intravenously; Percocet, oxycodone, and other painkillers; none stayed down and I continuously threw up.

12/20 - Pain was enormous and unrelenting since I could not take the stronger painkillers… until they came up with a pain killer formula of mixing hydrocodone and a muscle relaxant - Still could not use restroom or move.

12/21 – Able to hold food down and pain was under control. I began to move my knees and leg and initiated getting up on my own. Going to the restroom is a strict military activity…one must have a nurse assistant to assist your movement. So with IV tubes and a steadfast limp…plus a walker, off I went to the restroom a few times per day. I wanted to go home. However, since the pain was not under control I had to wait another day.

12/22 – Showed them how great I could walk everywhere without saying ouch…and the pain medication was working. They allowed me to go home.

Week 1 - out of the hospital I go!

Both physical therapist and nurse visit you. The physical therapist does the upmost to get your range of motion to 90 degrees. The pain is so severe that you must take the strongest pain killers to get the angle. I found myself not being fully aware of my surroundings and began to insist on getting off the narcotics. The argument ensued that I either take the pills or get my range of motion or I would not have a normal gait. I chose to get off the strong stuff and bite the pain bullet. I got my 90 degrees with more pain than I had if I delivered triplets.

They insisted first a walker, than a cane. I was walking on my own by the end of the week.

Previous leg conditioning and being in excellent shape helped me have the hip and leg strength to support a weaker knee. Thus, by the end of the first week, I was walking ¼ mile and doing my rehab exercises. I was still in a llot of pain.

Week 2

Again, the physical therapist did her visits and the nurse gave up on me. She defied that I should be waking without a walker. The physical therapist wanted to pursue the 90 degrees but I decided to now develop that daily miracle act after I did isometric muscle exercises….and I used minimum pain killers.

I was now walking a half a mile…without pain and with more confidence. It was the bending that was giving me pain. I began teaching my physical fitness exercise class again.

Turning point-I now think of future running. I went back to the principles of distance training and decided to begin at the first beginner level of movement. Walking for duration. I decided to begin walking for 1.5 hours, and then 2 hours, and then 2.5 hours…by week 4, I walked 3 hours. The swelling occurred after each bout but ice and elevation took it down. Allowing an every other day approach helped with walking adaptation. Muscle rehab continues as it relates to the weak leg.

Week 4

Time to work on getting my life back on track. I decided to begin on my actual cross-training/ running program which I feel I can live with. I took my normal swim…1/4 mile and it went well. The bike was so painful…and that created much more stress with regards to flexion on the knee. I am fairly sure I pulled a ligament with that or with the physical therapy of continuing bending the injured knee. Regarding running…no point in doing it since my knee was not ready for impact…the pain from the bike gave me pause. . Rather I worked on form, technique and leg strength by doing uphill drills in San Antonio…with and without weights. Sadly, the initial ligament pain came back. Later in the week, I went for the walk/jog on soft ground and the easy jog does not aggravate the knee as much as the bike does.

Week 5

Now working on duration of the walk/jog…on soft ground got up to 7 miles. Note: my walk is faster than the “jog”, but biomechanically it is easier and feels much better when I jog. Walking seems to aggravate my new knee. Reflecting on my 45 plus years of running…it is easier for me to run than to walk… Lastly…define “jog” for a TKR person who was once a runner. Ok. Reality, I spent 1.5 hours with a walker friend of mine who briskly walked while I jogged”. We stayed together the entire 6 mile way. I “jogged”; she walked and at same speed as my jog. How did I feel? Still great. I was out; I was doing the preliminary biomechanics of a future run movement. Why not run? There is still a differential of pressure with impact when you go to a full stride run. The foot strike is mostly on the toe box which puts enormous pressure on the shin and knee. When you a short step up and down jog, or slide, you simply raise each leg slightly and alternate accordingly with the same pattern of movement. The initial landing strike is mostly on the heel.

Oh darn…do you get aerobic benefits? Yes and no. More blood is being circulated through heavier breathing, but no, your previous cardio vascular system will not get near to your normal paced “easy run”. Goal of week 6…nope, not the actual “run” movement…but rather increase duration of my “jog”. Remember, TKR has created a reduced amount of muscle which does take a while to strengthen enough for full impact. Back to rehab for hamstring curls and knee presses…plus the up and down movement reminiscent of an easy jog. I was reminded by my lifelong orthopedist that my range of motion was still unacceptable; meaning I am heading toward doing a bend to be able to do a “bow” position as in yoga. Two times every day, I practice this extended bend for 2 min.-each leg.

Week 6

There is no doubt in my mind that “cross-training” will be necessary to maintain the new knee integrity during my running bouts. Interestingly, my biking both recumbent and regular still aggravates the muscles on the inside of the knee. Jogging, not running seems to not inflame as much and will remind you of many of the rehab exercises given in your rehab. Most of my jogging is uphill with little impact; downhill I walk. In the flat areas I do a jog but mostly I go heel to toe and concentrate on a perfect forward movement so no lateral knee movements occur.

Week 7 I am now feeling the advantages of a more flexible knee and am able to have impact on it while running. The impact now hits the non-surgical part of the knee. I still do extensive stretching and leg extensions in 3 directions: lateral, left, and right for total quad strength. Then I flip over and do the hamstrings. I did my first 5K…albeit the low height of jogging…but, as the last mile came I did gointo a run and wow, did that feel great passing folks. (Some of you must realize I used to win many races my entire life!). I somehow won lst place…hardly anyone else in my age group. My nurse friend, Charlene Penick was with me keeping me safe from anyone getting in my range of step.

Week 8

My confidence has soared with knowledge that I most likely could run again…such that I decided to reign in my son, Thomas, to do the Gasparilla Distance Classic, in Tampa 15K – 9.3 miles with me. This is no easy feet…no matter what shape one is in. However, I was determined to run the entire way. I then set forth to gain my aerobic ability back by doing continuous uphill repeats at quicker and quicker paces such that I will get slightly anaerobic. Again, my impact going downhill was lessened by walking and barely jogging with a knee brace on.

The 15K run @ ave. 11:00 min. pace; that was the pace I trained for. The 15K event was a success…in that: a) I felt comfortable the entire way and b) I kept my trained pace the entire way and finished strong. My son got all the water for me so I never moved laterally on the course, but rather one direction and in one “imaginary” lane. My gait was a practiced one with the heel to toe strike exactly equal to what was done in practice.

My 2 month total knee report was exemplary and range of motion plus extension was above average; all x-rays showed adaptation of the new knee inside.

Week 9

Interesting development of sadness during this time; I know longer was running with my regular running folks and now was realizing I may never gain the speed nor the desire to train as I used to. Many of the folks whom I usually see and talk to have their own group and respective training goals…I was way apart from what they were doing. Sadness and disappointment came to me frequently when I went to places with lots of runners whom I knew, banquets, etc. and seeing how they felt so “sorry” for me. Perhaps I was oversensitive but soon I developed a feeling that I was an outsider in the running world and many who I trained for years. There was no doubt that my personality changed to be more introverted and my confidence as a runner was at an all-time low. I struggled to look for new identities; took up quilting, threatened to learn to cook, wanted my son married and have grandchildren more quickly…you name it, I was without a “running goal” which is how I have motivated myself for forty plus years; and was in fact my social group. Now, I had none of my old friends around; and was now forming a totally new bunch of friends who helped me from day one to get back on my feet. It was funny, one day Mary Anne and her husband Ed, initially were going to walk with me a few weeks after surgery, but my walk was so slow and it was so cold … they almost froze. Gradually my new group of folks emerged and would be my salvation. They accepted my “odd knee”, my odd run, and all the elastic bands that went with it.

Week 10 Soon it came to me to turn the depressed corner and turn on the “goal setting” button. The hell with sulking and training at a dead slow pace. I decided to do the Iron Girl half marathon and try to come in the top five in my age group. The date was April 14th and I had a bit more than a month to get my distance and speed going. This training mode is known as a tennis player’s “sweet spot”. I get a time goal in my brain and then I figure out ways to somehow get to it.

Back to good old fashioned training; duration…on soft surfaces to lessen impact. I now had a few training partners who definitely kept me motivated. I had a hill trainer partner, Monica and we got really strong doing hill repeats. I began racing one mile each week uphill. I employed the longer, advanced tempo work for mileage and for stamina…9 miles. All long runs were done on soft ground and on one Sunday I did make 14 miles; close enough.

Weeks 11 – 12

Feeling stronger than ever; I began thinking a marathon may be possible. Uphill running was my strength so I picked Grandfather’s Mountain in North Carolina as an option-in July. Bingo, I registered for it and began to arrange myself a marathon schedule.

Meanwhile at the ranch, my Take…The First Step Training Center business I worked out with my trainees sometimes up to 5x per week. I felt my upper body and core getting stronger. I was encouraged that all the plank, and abdominal work, plus endless hip strengthening were giving me a much more balanced run. But the natural physical balance was not really there. A new problem was now emerging on my good side…the right side. A TKR weighs 1.5 lbs. and can definitely be a factor in keeping the foot strike and hips even, and of course the tendon and ligaments uninjured It was a continual fight to keep my left leg-TKS strong, since protecting for almost a year prior to surgery and after made for a habitual compensation on my right leg. To the point-my right gluten began to hurt due to so much overuse. This problem was actually there before TKS, but I wanted to continually progress not regress. Despite rolling with a roller, massages, etc., there was no denying that I was nearing a chronic problem with the right glute. Lipomas began to form. A lipoma is a growth of fat cells in a thin, fibrous capsule usually found just below the skin and can carry nerves in it and become quite painful. More on that later…since I resolved to complete my Iron Girl Half marathon in a few weeks.

Weeks 13 – 14

Distance training and mixing speed with a new leg can be a challenge. Do you ever get the TKR leg able to pick up as quickly as the normal leg? Trying out a track session was a real eye opener. I found that I physically could not lift the TKR leg quick enough to keep up with my right leg. TKS changes your muscle mass around the knee due to some of it being cut out; and you have to wonder what fast twitch muscles may still exist. The reality was that at this point of training for “speed” was not going to be a glowing success story. My new training goal was going to be a 10 minute pace…that was as fast as I could go. I trained so much on the uphill’s, that given the Iron Girl course, I had to face 4 uphill bridges. So I began to practice more racing the uphills; the downhills I would lose some time since I had to go heel to toe…remember, still low impact on the TKR is what I promised myself to employ at all times.

Week 15

April 14th – the Iron Girl Half Marathon. It was a perfect weather day; warm so my muscles could stretch out and windy so a bit of coolness was in the air. If it were cold, my race could not be done at this point. The TKR takes at least 1.5 – 2 miles to warm up and become fluid…there is much stiffness on it still and the muscles surrounding it our quite new. I went smoothly to mile 9 or so and began to feel the familiar feeling of being undertrained with heavy legs. I knew I did not have enough distance runs so I did have to work extremely hard with my upper body as it related to arm movement to carry my pace. Of course my asthma-exercise induced pops in there, making my breathing increasingly difficult. I did forget my inhaler. Always the excuses…right?

I tore up the last hill, ran way to fast on the downhill which was a corkscrew and got a muscle spasm on my right leg 300 yds. before the finish line. I ran through that excruciating pain and was delighted to know it was not my TKR leg…I finished strong and happy. I came in first in age group; ave. 10:01 pace.

Week 16

All week ice and bike with some short runs; my TKR leg was fine now time to address my imbalance from my left leg to the right leg, which was really defined after the race. Was it time for orthotics? I called for an appointment and began to experiment with heal lifts…1/4” thinking to balance both legs. I certainly didn’t work on my right leg since the hip pain went up a few notches. Then reading that it is the TKR leg which can be the shorter leg, I tried it on that side. Then the pain went to my new knee.

Week 17 – 18

I took a week off and got into biking while making my experiments with leg length fixes. I am continually reminded that one should not run with a TKR; however, this would have occurred with distance walking as well. I just found the imbalance a bit sooner. I was now planning on having my orthopedic surgeon look into seeing if my right knee could somehow be evened out a tad. That option was in my mind as was orthotics. Orthotics has never worked for me before so I put that on hold if nothing else worked. I would need something done even if I went to walking so I was already preparing mentally for possible surgery on my right knee … just arthroscopic.

Then, I fell. It was at Croom, a dirt road-again soft surface, but with too many hidden rocks which I seem to not see as clearly as some of the others I ran with. Meaning no one else fell. My leg lift was habitually very low since I taught myself to train with little impact. It was just one little ole’ rock which I caught my right foot on and led me to land full force on my right leg/knee and shoulder. No way was I going to fall on the TKR side. Big mistake. Prior to the TKR, I had already fallen a few times on the right side due to my left knee collapsing and already had a minor tear in the rotator cuff. This fall completely tore my rotator cuff to a point where I barely could use my shoulder and arm for a week or so.

Week 19

I continued my training regimen of biking and running; but now put an emphasis on biking. My right knee, the lipomas, and my right shoulder were now becoming a chronic concern. It mirrored a complete example of imbalance and was only going to get worse. Once a runner or distance walker, swimmer, biker, loses the equal distribution of weight, so many peripheral injuries begin to occur. I do not run in pain and have rarely done so. Even at the height of knowing I was having the TKR done, the motive it was more due to having my knee collapse time and time again; not because of pain. Having osteoporosis, a condition I am also requires vigilance in not falling. Now it was time for me to get the MRI’s done…both for the knee and the shoulder.

Week 20

I did my first triathlon since TKR. I was extremely nervous given the swim being my weakest link and with a bad right arm from former falls. However, it was easy to walk a bit in the water due to the shallow parts being dominant. Phew! My bike was not stellar, but strong enough to give me a middle of pack status in my age group; and my run was surprisingly good. I wasn’t sure if my TKR would make the transition from biking to running; but it did and the 3 mile run put me up there in my age group. Traditionally I come in last in the swim, middle in the bike, and lst or 2nd in the run…pretty much the same is what I did. Came in 4th place in my age group…but I was happy as heck to recognize that my TKR could transfer from the bike movement to the running movement-no walking.

Week 21

I fell hard on my long run. “I was a train wreck” according to the radiologist who read my MRI report. Multiple contusions, large tear on the humeral, swollen joints in the entire arm, etc.-that is just the arm. The knee; ACL sprained, torn meniscus, and other lovely marrow related injuries. And that was my reality I had to live with until getting it fixed. Time for another surgery…hmm knee or shoulder first? You cannot do both since one has to be healed in case of falling. Who me fall? There is no question of me having to protect myself from falling. Well, we did the knee right away, a week after the MRI. Great news! The surgery was successful, not that invasive at all (arthroscopic…but only 45 min. or so). My cartilage is plentiful, meniscus is intact and the marrow stuff was removed along with arthritis. This resulted in my lipomas going away and a much more even foot strike.

Week 22 My new TKR knee is now my strong knee And strong it is. To strengthen it, I wear a bit of a weight around my leg when biking and do weight training every other day. Now my right knee is healing and my left knee is taking the impact a bit from my right. About time the left TKR helps out!

Week 23

I am now back to biking and allowing my right knee to heal. My left leg continues to get stronger as I depend on it longer. My 6 month report of the TKR is way above expectations with a high range of motion; above average flexibility and above average in leg strength. I am happy despite the upcoming shoulder surgery in two weeks.

Week 24

I am now back to regular training with biking, track, tempo, and distance running being part of my 3 day regiment, and biking on off days. I cannot swim now, but will plan on that after another month or so. My shoulder surgery will prevent much outside biking and running. I will go into surgery as strong as possible and hope for a quick recover via rehab. My plan is to not lose my running gains, and will walk vigorously uphill. As for biking, I plan on doing inside spinning classes for two weeks.